Evaluation of the renal function patients with early carbohydrate metabolism disorders and arterial hypertension in the primary healthcare

Objective. To evaluate markers of early chronic renal damage (podocin, urinary and plasmatic cystatin C, interleukin-18), to identify their associations with albuminuria level and glomerular filtration rate reduction in patients with early carbohydrate metabolism disorders. Materials and methods. A study that included 122 persons (mean age 46.2±8.2 years) with early carbohydrate metabolism disorders was carried out. Level of high-sensitive C-reactive protein (CRP-hs) was determined using turbidimetric analysis of latex particles agglutination. Interleukin-18 and tumor necrosis factor-alpha concentrations were also determined. Levels of podocin, urinary and plasmatic cystatin C were analyzed using enzyme-linked immunosorbent assay. The degree of associations of parameters and conditions was assessed in terms of odds ratio (OR) indicators. ROC curve analysis method was used to evaluate the diagnostic capability of model in univariate outcome prediction. Model accuracy was determined as a value of the area under the curve (AUC). Differences were considered statistically significant at p<0.05. Results. Albuminuria level increased by 3.4 times in podocin elevation in the spot urine ≥0.16 ng/ml (95% CI 1.9–6.1; p<0.001) and by 2.3 times in cystatin C elevation in the blood plasma ≥0.6 μg/ml (95% CI 1.3—4.2; p=0.002). The risk of glomerular filtration rate reduction lower than 60 ml/min/1.73 m2 increased by 6.4 times in podocin elevation in the spot urine ≥0.18 ng/ml (95% CI 3.4—12.0; p<0.001) and by 1.5 times in cystatin C elevation in the blood plasma ≥0.57 mg/ml (95% CI 1.1—3.4; p=0.033). Conclusion. The study demonstrated that monitoring of podocinuria and cystatin C in the blood plasma can be used as screening criterion for nephropathy at the earliest stages of renal damage in carbohydrate metabolism disorders in patients with prediabetes.